- TO:
- ALL COUNTY OFFICES
- FROM:
- ALYSON CAMPBELL, DIRECTOR
- SUBJECT:
- MO HEALTHNET CHIP REMINDER
DISCUSSION:
The purpose of this memorandum to is remind staff of the need to review MO HealthNet CHIP eligibility factors and premium payment information with applicants of MO HealthNet for Families (MHF) and MO HealthNet for Children (MHK).
Uninsured children whose household income is above the MHK Non-CHIP limit, but below 300% of poverty are potentially eligible for MHK CHIP coverage. The benefit package for CHIP coverage is the same as that received by Non-CHIP children, except non-emergency medical transportation is not provided and the eligibility start date varies by category.
NOTE: Approval in the CHIP Premium group does not mean a child will receive coverage. It means the family is eligible to buy medical coverage for their child(ren) through the MO HealthNet for Kids CHIP Program.
All premium group children must also meet the following criteria (Refer to Income Maintenance Manual section 0920.020.00 MC+ ELIGIBILITY FOR CHIP CHILDREN (MC+):
- uninsured for 6 months
- no access to affordable health insurance
- payment of premium
- gross income test
- net worth of $250,000 or less
CHIP coverage falls into three groups:
CHIP No-cost
Children in this group have household net income above non-CHIP maximum and gross income up to and including 150% FPL.
Coverage for children in the No-Cost group begins with the first day of the month of application, provided the child is subsequently found eligible, and was not obviously ineligible for the entire month of application and any subsequent month prior to approval. If a child is obviously ineligible for the entire month of application and any subsequent months prior to approval, MC+ healthcare coverage begins with the first day of the month in which eligibility is met.
NOTE: Children in the No-Cost group are eligible for prior quarter determination, effective September 1, 2007.
CHIP Reduced Premium Group
Children in this group have household gross income over 150%, and at or below 225% FPL.
If a child is eligible in the month of application, coverage for children in the Reduced Premium group begins with the date of application or the date the premium is received, whichever is later. If a child is obviously ineligible for the entire month of application, coverage begins with the first day of the month in which eligibility is met or the date the premium is received, whichever is later.
Children in the Reduced Premium group are not eligible for prior quarter benefits.
Full Premium Group
Children in this group have household gross income over 225% and below 300% FPL.
For children in the Full Premium group, coverage begins 30 days from the date of application or the date the premium is received, whichever is later.
EXCEPTION: For premium group children determined to have special healthcare needs coverage will begin on the date of application or the date the premium is received, whichever is later. The exception to the 30 day waiting period only applies to the child(ren) with special healthcare needs, other children in the assistance group are still subject to the 30 day waiting period. Refer to Income Maintenance Manual section 0920.020.05.20)
Children in the Full Premium group are not eligible for prior quarter benefits.
NECESSARY ACTION:
- Review this memorandum with appropriate staff.
AC/mks